Spinal cord injury increases risk of cardiovascular disease

5th September 2013

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In Neurology, Jacquelyn Cragg (School of Population and Public Health, International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada) and others noted that new findings indicate that spinal cord injury independently increases the risk of heart disease and stroke—suggesting a need for targeted intervention and prevention strategies in this patient population.

Cragg et al stated: “While most of the literature with respect to cardiovascular disease and spinal cord injury has shown a higher prevalence of risk factors for cardiovascular disease, relatively few studies have examined the prevalence of cardiovascular disease itself and corresponding risk estimates.” They added that none of these few studies directly compared the risks of cardiovascular disease in patients with spinal cord injury with these risks in patients without spinal cord injury. The aim of the new study, the authors reported, was to “estimate the prevalence of heart disease and stroke outcomes in the spinal cord injury population, to compare their risk with a non-spinal cord injury population, and to investigate this relationship after controlling for confounders.”

The authors, using data from the Canadian Community Health Survey, found 60,959 individuals (including 354 with a spinal cord injury) for their analysis of the risk of heart disease in patients with spinal cord injury and 61,303 (including 356 with a spinal cord injury) for their analysis of the risk of stroke in this patient population. They noted: “Among individuals with a spinal cord injury, the prevalence of stroke was 5.7% compared to 1.1% in individuals without spinal cord injury. Similarly among those with spinal cord injury, the prevalence of heart disease was 17.1% compared with 4.9% in individuals without spinal cord injury.”

The odds ratio of heart disease and stroke were 4.01 and 5.68 times greater, respectively, in patients with spinal cord injury. Both of these ratios were reduced after adjusting for age and sex, but continued to be higher—2.72 for heart disease and 3.72 higher for stroke—than in patients without spinal cord injury. Cragg et al said about the adjusted odds ratios: “To put those values into context, the heighted odds ratios reported here are similar in magnitude to the estimated odds ratio in the general population for the relationship between smoking and myocardial infarction and diabetes and myocardial infarction, and are in fact higher than those for the relationship between hypertension and myocardial infarction and abdominal obesity and myocardial infarction.”

Cragg et al claim that risk factors for cardiovascular disease are “amplified” in patients with spinal cord injury adding that in addition to the immobility, “Individuals with spinal cord injury have unique disadvantages that may further contribute to these risks relating to the disconnection between autonomic circuits and supraspinal control.”

Concluding their findings, the authors wrote: “Research of this kind will ultimately lead to interventions and targeted prevention strategies addressing modifiable risk factors for cardiovascular disease in individuals with spinal cord injury.”